This column is written in response to the many requests for advice on premature ejaculation that I have recently received.

Premature ejaculation is an inability to control ejaculation sufficiently to allow both partners to enjoy sexual intercourse. Ejaculation may occur even before penetration takes place or very shortly after penetration. Usually normal erection takes place followed by ejaculation which takes place too rapidly and before there is time for fulfilling intercourse. After this, the penis becomes flaccid (limp) again and returns to its former size without the anticipated sexual gratification in both partners.

Premature ejaculation is a problem experienced mainly by younger men who are not experienced sexually and may have learnt rapid ejaculation during adolescent masturbation when timing and control were unimportant. It may also occur after a prolonged period without sexual intercourse. A new sexual partner or unusual, extraordinary stimulation can also cause ejaculation to occur before it is desired.

Premature ejaculation is by no means an unusual problem and there are reports of up to 20% of men experiencing this problem. There is no doubt that anxiety about sexual performance plays an important role in hastening ejaculation in some men and that with sexual experience and maturity this problem may work itself out without any intervention. It is, however, one of the sexual problems that is potentially easily treated by reducing performance anxiety and improving ejaculatory control using some simple exercises.

The Squeeze Technique was developed by the famous sex therapists Masters and Johnson to help men control their ejaculatory reflex. The man can do these exercises alone or with the full cooperation of the sexual partner. They are simple and effective but require patience, practice and an empty bladder at all times. The penis is stimulated to an erection. As soon as the man feels he wants to ejaculate, the ejaculation is stopped by squeezing the tip of the penis for a few seconds by placing the thumb and forefinger just below the glans. Once the urge to ejaculate goes, stimulation should start again. Each time he feels he is at the point of ejaculation it is stopped by squeezing the tip of the penis. These exercises can continue for up to 20 minutes or until the man decides that he must have an orgasm.

These exercises should be repeated daily for a few weeks until it is possible for the man to have longer periods of stimulation where his ejaculatory sensation is under control. Once he feels that he has gained sufficient ejaculatory control, sexual intercourse can take place. Initially this should start without thrusting movements with the penis in the vagina for 10 seconds or so. If this goes well, thrusting movements can begin. If the man feels he wants to ejaculate too quickly, he should withdraw his penis and apply the squeeze technique again.

There are drug therapies that can be used. The SSRI?s can be effective in delaying ejaculation and improving sexual satisfaction in both partners. A physician should be consulted about this. Premature ejaculation is distressing and confusing to both partners. These exercises and your own modifications of them can go along way towards gaining the all-important control over the ejaculatory reflex.